Thursday, September 18, 2008

Investing in a turbulent stock market

These are rough, interesting days on the stock market. Up until fairly recently, I was only vaguely aware of what was going on the market but didn't really think it affected me directly. I learned about the history of NYSE when I went to see it in action when I was still in elementary school, and it was still a very busy floor with men in suits running around like chickens with their heads cut off. I hear it's a bit different now with modernized computer systems! Then, as a senior in high school, we "traded" stocks for two weeks in my government class, buying stocks and following them in the newspaper. It was a fun game, or so I thought, again with no real consequences. I also remember Black Monday in 1987, talking about it in government class and seeing adults walking around with furrowed eyebrows. But I was a teenager who was more concerned about college applications and crushes on boys...

Come college, I happily took a variety of classes - there were so many interesting topics to choose from! I took language classes, geography classes, history classes, I even tried music theory, which I absolutely despised. I started off pre-med, so I also enrolled in chemistry and biology classes. I eventually became a French major, having tired of science classes. Did I ever take an economics class? No way. Sounded too boring. Perhaps if the department could have come up with some sexy titles to the courses, I might have, but I'm not even sure then because that was a section of classes in the course guide that I pretty much skipped over.

As you can guess, I eventually ended up in medical school. I attended a school with a very innovative curriculum which included a block at the end of our fourth year with classes relevant to residency, such as medical Spanish, yoga (to help us relax through those grueling intern years), and I honestly don't remember what else. We did have a lecture on paying off our loans which basically gave us the message to pay them off as rapidly as possible, to keep living like a resident after residency in order to make large payments on our loans. Certainly that was sage advice, but that was it for our financial education.

Needless to say, residency was about the same. Our daily noon conferences was excellent medical lectures. Each year we were given a talk on choosing a job which included learning about different types of malpractice, head hunters, and helping involve one's spouse in the decision. Very helpful, but again, not much about how to handle the money we were about to start making. Can you see a theme here?

So, I eventually landed in my first job. I signed on the dotted line to put the maximum amount of money I could into a retirement account because my parents had taught me that saving was a good thing. I chose the default funds to put my money into. For whatever reason, I didn't consult my husband on this choice, I think perhaps because I was overwhelmed by all the paperwork I had to fill out on my first day of work, and I figured that I was being guided in my investment decision by someone who knew more than me. And, as you can gather, I didn't know a whole lot. And my husband would have been an excellent resource.

Happily, the first few years, the economy was still relatively strong, although to an astute observer, there were signs of the current problems. As I started hearing about the stock market losing losing losing, I decided to take a look at my portfolio. Yikes. I had the feeling that this was going to be baptism by fire! The glorious 90s were over. Ignorance was bliss. Since then, I have made the effort to educate myself on the art of investing. I say art, because unless you are completely invested in index funds, there is an art to it. I just finished an informative book my father-in-law sent us called, "The Little Book of Common Sense Investing," by John Bogle, the founder of Vanguard. Although I prefer to read novels in bed after a long day of work, I read this book cover to cover. It was actually pretty interesting and well-written, without too much jargon for a lay person like me. Mr. Bogle focuses on the index fund, his own creation, which has gained many supporters in the financial fields. Basically, this is a fund that owns the entire stock market, thereby minimizing risk, and also, by owning a little bit of everything and not actively buying and selling stocks trying to guess who to invest in, there are low costs associated with it. This is investing for both the non-investor who doesn't have the time and/or skill and/or luck to buy and sell stocks daily, as well as financial wizards like Warren Buffett and John Bogle himself. It is a beautifully simple plan. And the book, although focusing on this particular type of fund, also teaches the reader about other types of investing. I highly recommend it. I obviously still have a long way to go, but I am an active learner now. Honestly, I would still rather read about neurofibromatosis than finances, but I also realize that I would eventually like to retire, preferably before the age of ninety...

The moral of this story is that perhaps some basic classes on investing could be incorporated somewhere into our education. The challenge is that there is just an amazing fount of knowledge we already have to acquire in medical school and residency. Where would this fit in? Maybe we could have quarterly lectures on it during residency or medical school. Many of us become physicians "to do good," not just to make money, and frankly, these days, there are other fields to go into to make money; but there is no reason we shouldn't have the resources to be wise with what we do take home. We work hard for our money, and it should work hard for us.

Friday, September 12, 2008

not too much

Just a quick note from Colorado! I'm at my District VIII meeting, being awed by the work that pediatricians all over my district are doing. It's both inspiring and motivating to be surrounded by leaders in the field. It's also comforting to hear about the struggles they face that I too face, I am not alone!! I'll have lots to report when I get back, new resources, new websites, new ideas. For those of you who may not know what District VIII means, it is a district of the American Academy of Pediatrics, and it includes Alaska, Hawaii, British Columbia, Alberta, Washington, Oregon, Montana, Idaho, Utah, Wyoming, Nevada, Colorado, Arizona, New Mexico, and Uniformed Services West. It's the largest district geographically and obviously quite diverse.

Sorry this is short, but I have limited time!

Wednesday, September 10, 2008

primary care shortage

All the buzz in the media and on doctor blogs in the past day or two has been the announcement that, according to a survey published in the Journal of American Medical Association, only 2 percent of graduating medical students are going into primary care, primarily due to poor salaries and increased workloads. TWO PERCENT!!!!!! That is just frightening to think about, especially from the viewpoint of an already busy rural pediatrician. We, as primary care physicians, are already pushed to see as many patients as possible by our reimbursement schedules. I know that I am getting busier every season than I was the last. This year, my "slow" period consisted of approximately two weeks of slower days, then we picked right back, last year, my "slow" period lasted closer to one month; this year, I'm already seeing winter time numbers with school having been in session only for a few weeks....I'm afraid things will only get worse.

How about talking about solutions to this problem?! Neither candidate is addressing this specific problems. Then again, nobody is really asking them to. I have a proposal: mandatory one to two year service in primary care medicine prior to specialization. In other countries such as New Zealand, they have general practitioners (GPs) who tend to the primary care needs of their citizens. Perhaps we could do something like that here in the US. I have just recently completed my service time for the National Health Service Corps and although that system is severely flawed, it could be used a loose guide. I am now free to do a fellowship, if I so desire. I've learned a lot from practicing this kind of remote primary care medicine, and I think this type of background would serve me well were I to do further training.

This is by no means a perfect solution, and I'm sure I'm not the first to suggest it, but perhaps it could get people talking if it were put out on the table. I know that we, as physicians, already go through many years of training, and some would groan at an additional two years, but how else will we take care of an increasing population of baby boomers?? We cannot simply rely on foreign medical grads. We cannot rely on the whims of medical students. And, at least at this point, we cannot rely on improved salaries to draw medical students to primary care.

Thursday, September 4, 2008

health care

Today, I was reading another physician blog,, in between seeing patients (my charts were calling but I ignored them for the moment). One of his recent stories was entitled, "Choices in Swedish Health Care." In it, he discusses the socialized system of medicine in Sweden, a system somewhat similar to other socialized ones. This topic has been on my mind lately, especially with the election looming in November. Perhaps I shouldn't use the word "looming," but I am very concerned that a president will be elected who has not even mentioned the word health care.

I spent one month working at a pediatric clinic/hospital in New Zealand in 2004, another country where everyone has basic health care. It is also somewhat tiered, in that there are some options for faster care through a private-payer system. One of the big problems there, as in Sweden, was waits. There is, however, a fairly strong medical tourism trade with Australia, especially for people needing radiation therapy for cancer; people who can afford to live temporarily in Australia are able to start their therapy more quickly. At the time I was there, these waits were being addressed by the government, so hopefully, things have improved.

However, as we all know in the US, many people go without health care due to lack of health insurance. And, even those with insurance risk bankruptcy with a diagnosis of cancer, or a chronic health problem. We spend the most on health care of any first-world country, yet we have the poorest outcomes. What gives? Is that our technology is so advanced that we try to save those who likely would die in other countries? Is that our fees in health care are completely out-of-line with the rest of the world that we are just simply paying/charging too much? Is it the fault of the drug companies who make enormous profits are drugs that cost too much? I suspect it's a combination of all these and other factors.

The bottom line, for me, is that if we, as a country, feel that health care is a right and not a privilege, we need to be willing to make sacrifices, to change how we as doctors are paid, and to change how we as consumers define health care.

Tuesday, September 2, 2008

change is in the air

I love this time of year. The sunlight is already beginning to have a fall quality to it, the air smells fresher, and the nights are cooler. Change is definitely in the air!

When I first started this blog, I had plans to start a new job this coming winter, however, due to circumstances largely outside of my control, I will be continuing to practice here for a while. As you may know from reading my previous blogs, I do primarily outpatient care; our local hospital is ill-equipped for inpatient pediatric care. I worked hard as a resident to learn hospital medicine, and I'm afraid I'll lose those skills. So, I've decided to do some prn work as a hospitalist in Albuquerque. I am very excited about this, which is a little surprising to me, since I was very happy to leave the hospital as a resident. However, now that I've been away from that environment for some time, I really miss it! I had an interview last week, and it just brought this fact home to me. I like the challenge of these patients, I love the newborns, and it will be enjoyable to be around other pediatricians and pediatric support staff for a change. I think I'll learn a lot, I will refresh my skills, and I'll bring a unique perspective to the group, coming from a rural setting. I'm ready for this change/challenge.